Treatment Considerations for Children and Teens

Because of their developing bodies, children and teens have to take different amounts, formulations, and combinations of anti-HIV drugs than adults.

Children and youth might also require special treatments for side effects of HIV or anti-HIV drugs. For example, the widely used anti-HIV drug tenofovir can make youths' bones weaker and could endanger their long-term bone health. NICHD-sponsored research found that vitamin D pills may prevent this problem.

The best treatment strategy may be different for each child or teen. These are some factors that affect treatment:

Time of infection. HIV infections are different in young people who were infected at birth or in infancy versus those who were recently infected. HIV infection may progress rapidly to death in infants who are infected at birth. Because of this, it is recommended that all HIV-infected infants under age 12 months be started on anti-HIV drugs as soon as possible, even if they don't have symptoms. In older children, evaluation of their immune cells (CD4+ cells) and symptoms are used to help determine when they should start anti-HIV therapy.

Availability of pediatric anti-HIV drug formulations. Young infants cannot swallow pills or capsules and therefore require special drug formulations, such as liquids. Not all anti-HIV drugs available for adults have formulations that infants and young children can take.

Availability of pediatric dosing information. The doses of anti-HIV drugs that need to be given are different in children than adults, and also vary in children of different ages. Not all anti-HIV drugs approved for adults have been studied in children to know the right dose for children. Additionally, dosing information for some anti-HIV drugs may be available for older but not younger children.

Prior anti-HIV treatment. Some anti-HIV treatments stop working after a period of time because the HIV virus may become resistant to those drugs. For example, teens who were infected at birth might harbor HIV that has become resistant to some drugs during periods when they have trouble taking anti-HIV drugs that kept their HIV blood levels (viral load) controlled. See "treatment adherence" below.

Treatment adherence. Many children and teens are concerned about fitting in with their friends and may not think about future consequences as much as adults do. For these and other reasons, some have trouble taking their medication as directed. If medication is not taken correctly or as directed (called poor drug adherence), the virus may become resistant to the drugs. Many strategies can help improve treatment adherence among youth, including simpler treatment plans, text message reminders for taking pills, and support from HIV-infected peers.